Medically reviewed by
Vandana K. Patel, MD
According to the American Lung Association, 37 million Americans live with chronic lung disease like asthma or COPD. For these individuals, becoming infected with SARS-CoV-2, the pandemic virus that causes COVID-19, can seriously exacerbate the symptoms of their underlying condition.
As we continue to learn about the pandemic virus and the illness it causes, we are discovering that COVID-19 can affect lung health and function even in patients who were previously healthy.
Short and Long-Term Impacts of COVID-19 on the Lungs
COVID-19 affects multiple organ systems. When it affects the lungs, COVID-19 can lead to symptoms such as coughing, wheezing, and shortness of breath. These symptoms and other allergies develop as a result of the body’s normal response to fighting off the coronavirus. A look inside the lungs helps us see why.
In healthy lungs, air travels into tiny balloon-like sacs called alveoli. From there, oxygen from the air passes into small blood vessels (capillaries) where it can circulate to other parts of the body. But when a person becomes infected by a contagious pathogen like novel coronavirus, oxygen may have a harder time entering the alveoli and capillaries. This is because the immune system will create and release inflammatory molecules that help fight off the foreign invader, causing the small capillaries to leak fluid and pus (fluid and dead cells) to build up in your lungs. Pus can plug up the alveoli and cause them to collapse.
Research also suggests that the coronavirus (and the immune response it triggers) can damage the walls and lining of the alveoli and capillaries. This could be why long-term lung damage occurs in some people who had COVID-19, even after the acute illness is over. In fact, surveys in countries like the U.S. and Italy have found that less than 40 percent of people who were hospitalized with COVID-19 had returned to their “baseline” health within three weeks following their diagnosis.
In the long-term, the respiratory damage caused by COVID-19 can lead to issues like persistent shortness of breath and cough, reduced exercise tolerance, and fatigue.
Factors that Impact the Severity of Damage to the Lungs
Underlying health conditions are the main predictors of severe lung damage due to COVID-19. Both short- and long-term breathing difficulties due to COVID-19 are more likely to affect people who are older than 65, people who smoke, people with weak immune systems, and people with underlying co-morbid conditions like asthma, diabetes, COPD, obesity, and heart disease.
While ventilator machines can be life-saving devices for people who are critically ill with COVID-19, it is possible for ventilators to cause lung injury as well. Other types of coronavirus treatment—including how quickly treatment is provided—can also impact the severity of lung damage.
Disease severity overall will also impact the severity of lung damage, with milder cases of COVID-19 being less likely to lead to long-term lung problems.
COVID-19-Related Illnesses That Can Affect Breathing
Fortunately, most cases of COVID-19 are mild and do not lead to long-term complications. Others may experience COVID-related illnesses that can affect their breathing and overall health for months or more. These are a few of the most common COVID-related illnesses and issues being treated.
COVID-19 Pneumonia
Pneumonia happens when the lungs become inflamed and filled with fluid, typically as a result of the immune system’s response to the coronavirus. COVID-19 pneumonia usually affects both lungs.
Acute Respiratory Distress Syndrome (ARDS)
ARDS is a type of lung failure. It typically develops after COVID-19 pneumonia has progressed to the point where alveoli in the lungs are damaged, filled with fluid, and are not functioning properly. Many people suffering from ARDS require mechanical ventilation because they cannot breathe on their own. ARDS can be fatal, and even if a person recovers, they might have long-term breathing problems due to scar tissue inside their lungs.
Sepsis
Sepsis is a severe response to an infection that has spread via the bloodstream to multiple tissues and organs throughout the body — including the lungs. Sepsis is dangerous and can lead to organ failure, shock, coma, and death in severe cases. People who survive sepsis may also experience lasting organ damage.
Superinfection
When the immune system is busy fighting off SARS-CoV-2, it might not be as effective at protecting the body against other viruses or bacteria. This can lead to “superinfection,” or an infection with another pathogen in addition to infection with the novel coronavirus. This can cause additional stress on the body and increase the risk of complications, including damage to the lungs.
Hypoxia
Hypoxia occurs when the tissues in your body do not have enough oxygen in them. COVID-19 can lead to shortness of breath, decreased levels of oxygen in the blood (hypoxemia) and ultimately, hypoxia. If left untreated, hypoxia can lead to tissue damage in multiple parts of the body, including the brain.
Is COVID-19-Related Lung Damage Reversible?
Tissues can heal, and lung damage caused by COVID-19 can get better over time. Depending on the severity of the illness, type of treatments received, and a person’s underlying health, it could take a year or more for a person’s lungs to return to their pre-illness function.
In some cases, lung damage and scar tissue development may be permanent. For these individuals, long-term medical management and lifestyle changes may be necessary.
Preventative Measures
The best way to reduce your risk of short- and long-term lung problems from COVID-19 is to avoid getting sick in the first place. You can do this by:
● Practicing healthy lifestyle habits that support your immune system (e.g., eating a nutritious diet, getting enough sleep and exercise, managing stress, maintaining a healthy weight)
● Staying at least 6 feet away from people who you do not live with
● Wearing a mask while out in public that covers your face and nose
● Avoiding crowds
● Practicing excellent hand hygiene
● Getting a COVID-19 vaccine when eligible
If you do become sick with COVID-19, it is important to work closely with your medical provider and follow their treatment recommendations in order to minimize lung damage and prevent long-term issues. Get adequate rest and use all medications and breathing treatments as directed.
Some individuals may require physical therapy and other forms of rehabilitation to help them fully recover and learn compensatory strategies that will keep them safer and more comfortable as they go about their daily life. Long-term supplemental oxygen therapy may also be required in certain cases.
